In order to elusidate characteristics of mucosal patterns of gastric cancer, depressedgastric lesions such as cancer, ulcer, atypical epithelium and erosion were examined busing a magnifying endoscope GIF-HM. It was concluded that irregular nodule-like appearance and concomitant flattenedmucosal appearance were characteristic of gastric cancer (Figure 7). In the next place, to clear the diagnostic value in the case of carcinoma, 30 cases of thegastric cancers smaller than 20 mm (of wich 14 lesions smaller than 10 mm, 9 lesionssmaller than 5 mm) were examined (Table 3). In the case of minute cancers smaller than5 mm, the conventional endoscopy made a correct diagnosis in only 1 case. On the otherhand, the magnifying endoscopy made correct diagnosis in 5 cases. But even by themagnifying endoscopy, it was impossible to detect the lesion smaller than 2 mm anddistinguish the lesion smaller than 3 mm from other gastric lesions. Magnifying endoscopic findings were compared with stereomicroscopic and histologicalfindings in the lesions not correctly diagnosed by the magnifying endoscopy (Figure 10)

View full abstract

In order to evaluate the usefulness of Laser Induced Fluorescence Microscopy (LIFM), the microfluorometry of gastric cancer were studied. The fluorescence obtained by LIFMwas compared with that obtained by the standard fluorescence microscopy, using histologicalsections stained with hematoxylin-eosin (HE) and those sections without staining. In sections without staining, only the elastic lamina located in the wall of the vesselshowed strong fluorescence which could not be evaluated by transmission microscopy. In sections stained by HE, the fluorescence were observed in the foveolar cell, themuscularis mucosa, the fibrous connective tissue and the cytoplasm, which were stained byeosin. In particular, the subcellular structure in the cytoplasm of signet ring cell wasclearly revealed. On the other hand, poor fluorescence was observed in the nucleus stainedby hematoxylin. The spectroscopic study of fluorescence revealed that the fluorescence of sectionsstained by HE was those of eosin except the elastic lamina. These observations obtainedby LIFM were also observed by the standard fluorescence microscopy. By these studies, LIFM seems to have few advantage over the standard fluorescence microscopy. LIFMshould be rather applied for microirradiation, more selective microfluorometry and thetime resolved fluorometry than for the standard observation of fluorescence.

View full abstract

549 gastric ulcers, open or scarred, resected from 470 patients were step-sectioned forblocking with each slice being 5 mm in thickness for histopathological examination of theregenerative epithelium with special reference to its intestinalization. The results were asfollows : (1) About 70% of the regenerative epithelium revealed intestinalization. (2) Bothof the so-called 'complete' and 'incomplete' types of intestinalization were found. (3)Parietal cells and chief cells were occasionally noted in the regenerative epithelium ofulcers located in the fundic gland area or at the fundo-pyloric gland border. Based on the above findings, it would be assumed that regenerative epithelium frequentlytakes the form of intestinal epithelium possibly as a 'reversion' phenomenon at a stageof the regenerative process, and it may re-differentiate or remain as intestinalized mucosa(intestinal metaplasia) thereafter.There is a strong tendency to regard intestinalization as a premalignant condition. However, intestinalization was quite frequently noted in the regenerative epithelium asabove mentioned and therefore it seems to be unreasonable to connect it directly withgastric cancer.

View full abstract

We have evaluated the efficacy of ultrasonography (US) and computed tomography(CT) in comparison with endoscopic retrograde cholangiopancreatography (ERCP), percutaneoustranshepatic cholangiography (PTC), and angiography (AG), and discussed a rationaldiagnostic approach for the evaluation of obstructive jaundice. The subjects were 70 patients with obstructive jaundice, finally confirmed by subsequentsurgery or autopsy. In this study, US and CT achieved a diagnostic accuracy of 95% and 98%, respectively, in detection of the presence and level of an obstruction. Therefore, we consider that US, which is more nonivasive, more economic and simpler than CT, is the best initial procedure for evaluation of obstructive jaundice ; followed by CT only when the bilialy ducts should be poorly demonstrated by US because of body habitus or gaseous distension. US might be able to identify even the specific etiology of an obstructive lesion. In tumors of the bilialy tract and the pancreas including small and resectable ones, the diagnostic rate of US was high, 91% for bilialy tract tumor and 100% for pancreatic tumor, which was almost the same as that of ERCP, PTC or AG. This result suggests that US eliminates the need of invasive procedures in some cases before making decision of therapeutic approach, while CT was not so accurate diagnostic modality as US in small lesions. But in papillary tumors, small lesions of the distal common bile duct, and gallstone diseases, either ERCP or PTC yielding almost 100% diagnostic accuracy, is the most reliable procedure, while US or CT did not show a good diagnostic accuracy. Diagnosis of chronic pancreatitis with inflammatory mass was difficult even by all available methods, often misdiagnosed as pancreatic tumor. It will be necessary in such cases to introduce new devices such as aspiration cytology and to improve currently available diagnostic tools.

View full abstract

In 28 cases of ulcerative colitis, severity of the disease was compared with findings of barium enema and endoscopv. In cases of mild type, the barium enema showed rigid, irregular wall, disappearance of fine net work and granulation of the colon. The endoscopic picture showed congestive, edematous, hemorrhagic mucosa and small erosions. In patients with moderate type, the X-ray picture showed multiple patchy erosions and inflammatory polyps in addition to the findings observed in the mild type. In case of severe type, the X-ray picture showed four findings i. e.1) lead pipe, 2)pseudopolyposis, 3) combination of the two and 4) multiple large ulcers. The endoscopic picture showed extensive erosions, stripped mucosal layer (pseudopolyp), deep multiple erosions and sea of ulceration. Two cases who underwent emergent operation showed pseudopolyposis and stripped mucosal layer by barium enema and endoscopy. Extent of the erosions and ulcers were correlated to clinical severity in most cases. Emergent operation should be performed for the pationt with the findings of pseudopolyposisand stripped mucosal layer.

View full abstract

11 patients of campylobacter colitis were examined endoscopically, histologically, and scanning electron microscopically. Five of them were children and six were adults. The findings in child patients were severe compared with that in adult patients. The inflammation was recognized on the ileum as well as colon in the former cases, while the observation in the latter cases showed acute colitis. In mild cases, glossy appearance due to edema and slight reddening were noted generally. In severe cases, roughening, dark reddening and erosions on mucosal membrance, mucous pooling, and/or dilation of the capillaries with bleeding from their peripheral parts were the general findings. The differenciation between this colitis and bacillary dysentery or ulcerative colitis was thought to be (extremely) difficult. Histologically, crypt abscesses were observed in six cases. Frequent occurence of this finding seemed to be characteristic for campylobacter colitis. Apparent changes were observed on the microvilli using scanning electron microscope, although this was not a specific finding.

View full abstract

A New Method to determine the area of gastric ulcer endoscopically without complex procedure was invented. A rubber disk, 5mm in diameter, was used as a marker. And a round object, 25mm in diameter was designed as the ulcer model. The marker disk was set in the center of a round object similar to a gastric ulcer. This model was photographed at various LOD ("Lens Object Distance"), from 1 to 5cm, in difference of every 2.5mm consecutively. We used more precise apparatus to measure the LOD than previous experiment, so the value in that report is corrected. At first, the ratio of the object to marker area were calculated on the picture enlarged to the cabinet size photographes. An aberration ratio was less than 10% by using the GIF-P2 and P3 type endoscopes with LOD over 4cm and by GTF-B100 type endoscope with LOD over 3cm. The precise area of the object disk was then calculated without correcting the optical distortion (Table 1, 2, 3). Secondarily, in order to correct the optical distortion of the f iberscope, a transparent board traced with the endoscopic photograph of squares in the same LOD was employed in measurement in less than 3cm of LOD if the GTF-B100 type endoscope was used and in less than 4cm of LOD if the GIF-P2 and P3 type endoscopes were used (Table 4). By use of these transparent boards, aberration ratio was corrected to less than 10%. Therefore, it became possible to determine the precise area of the object disk endoscopically even in short LOD. The transparent boards were copied to glass plates so that the diameter of the visual field is made the same as the diameter of visual field of the endoscopic film. The measurement of the ulcer is simplified by mounting the glass plate directly on the endoscopic film.

View full abstract

Two cases of enterogenous cyst of the stomach are reported . Case 1. A 50-year-old man was admitted because of black stool . X-ray and endoscopic examination revealed not only gastric carcinoma of Borrmann II type but also submucosal tumor measuring 2.9cm in diameter. Total gastrectomy was performed and histological examination revealed the submucosal tumor to be a cyst within submucosal layer of the stomach. The wall of the cyst was composed of enteric mucosa and surrounding smooth muscle layer. Case 2. A 63-year-old man was admitted because of a relapse of chronic alcoholic liver disease. X-ray examination of upper alimentary tract showed a submucosal tumor measuring 3.0×2.2cm in size of the stomach incidentally . Because operative findings revealed the submucosal tumor to be a intramural cyst, enucleation of the cyst was performed. It contained mucus and its wall was composed of gastric mucosa and surrounding smooth muscle layer.Enterogenous cyst of the stomach is uncommonly experienced as submucosal tumor . It is difficult to differentiate the submucosal cystic lesions from another submucosal solid tumors such as myogenous tumor or aberrant pancreas . If exact diagnosis is made by the technique for biopsy of common submucosal tumors, it is alternative to follow-up the patient except for major symptom or complication.

View full abstract

A case of corrosive gastritis due to ingestion of formaldehyde was examined during theinitial acute stage. A 32-year-old male was admitted to our hospital after he had swallowed sedatives and approximately 10ml of formaldehyde solution in attempting a suicide. Roentogenogram of stomach taken on the 10th hospital day, revealed a rigidity of the corpus and f ornix with the hypersecretion of the mucous and giant folds A elevated lesion resembling to submucosal tumor was observed at the f ornix.Endoscopic picture taken on the 11th hospital day showed edematously swollen gastricfolds with redness, erosion and white coats on the entire corpus and fornix. The elevatedlesion covered with white coats was observed. At the 19th hospital day, the elevated lesion on the fornix was disappeared. Therewere some linear redness with surface coats was observed on the corpus. At the 28th hospital day, the above mentioned abnormality was improved .Esophagus was not impaired during the observation of early stage.

View full abstract

Retrograde jejunogastric intussusception is an extremely rare complication following partial gastrectomy and gastrojejunostomy. In this report we describe a patient with acute retrograde jejunogastric intussusception, which occured after surgery for uterus carcinoma. A 70-year-old woman had undergone, subtotal gastrectomy with Billroth 2 anastomosis for gastric ulcer, 17 years prior to this admission. She suddenly complained of epigastralgia and vomiting 2 days after abdominal hysterectomy for carcinoma of uterus. Both upper gastrointestinal radiographic and endoscopic examinations preoperatively revealed retrograde intussusception of the jejunum into the gastric remnant through the gastrojejunal stoma. In an emergency, operation was performed 11 days after the onset of the symptoms. A retrograde intussusception of the efferent loop was found. Because the incarcerated efferent loop was inviable, this portion of the efferent limb was resected and the end-to-end anastomosis of the jejunum was made. There was neither ulcer nor polyp in the resected necrotic jejunum. Eight months after operation she remains asymptomatic.

View full abstract

A case of 57 years-old male with early cancer of the papilla of Vater was reported. He had loss of appetite and general malaise, then the abnormal high level of the serum LAP, Al-P and .γ-GTP was detected. Hypotonic duodenography, duodenofiberscopy and ERCP showed the tumor of the papilla of Vater. Biopsy specimen showed the atypical glands (Group IV) which suggested the carcinoma, then pancreaticoduodenectomy was carried out. The postoperative prognosis of this patient is good. The histology of the resected specimen suggested that this tumor originated from the common channel of both ducts and also suggested the malignant transformation of the adenoma. The tumor was about 15 mm in the largest diameter and was growing from the common channel into the lumen of both the common bile duct and the main pancreatic duct. The greater part of this tumor was recognized as the benign adenoma, but the adenocarcinoma was observed in the smaller part near the orifice, which showed the high cellular and structural atypism and infiltrated into the Oddi's sphincter. The histological transition from adenoma to adenocarcinoma was also observed. It was concluded that this tumor would be regarded as the early cancer of the papilla of Vater originated from adenoma.

View full abstract

A 20 year old female was admitted to our hospital complaining of tarry stool andsevere abdominal pain, several hours after she had taken two tablets of cathartics (sennoside A & B 12 mg/tablet). She had been well without constipation until half a day before admission. Colonoscopy and Ba enema examination were performed within a few days afteradmission and they showed severe colitis localized within the right side of colon. The mucous membrane of the rectum, sigma and colon descendens were comuletely intact. The views of endoscopic pictures and pathological findings of her biopsy specimens taken from the colon ascendens bore a close resemblance to those of fulminant ulcerative colitis, although this patient had never complained of diarrhea.She had suffered from constipation for about 3 years. As it had been a mild case, she had seldom taken cathartics orally. In 1943, Heilbrun described a special colitis caused by the daily and continuous ingestion of irritant cathartics over a period of at least 15 years which was usually localized to the colon, from the cecum to the proximal transverse area. There were irreversible changes such as shortening and an extremely smooth flat and atrophic mucosa of the right side of the colon resembled to burnt out ulcerative colitis in Heilbrun's cases which resulted in protein-losing gastroenteropathy and malabsorption associated with factitious diarrhea. Although our patient had used irregularly one or two tablets a day of the same cathartics as mentioned above for only half a year, she suffered from severe bloody diarrhea and had melanosis coli. Her complaint disappeared 7 days after the admisson by the therapy with antibiotics and dietary treatments. The fluoroscopic and endoscopic findings performed 21 days after admission were almost normal. In any case, we clinicians must emphasize that only a pretty small dose of cathartic tablet on the market used by many people arbitrarily without prescriptions should be able to damage severely mucous membrane and cells of neuromuscular system of the colon contrary to our expectations.

View full abstract

A 22 year-old male with juvenile polyposis coli was reported. On roentogenographic and endoscopic examination nine polyps were recognized in the colon and rectum. Six of the nine polyps were pedunculated and were removed by endoscopic polypectomy. Biopsy specimens were taken from the other three sessile polyps. Histopathologically, those polyps but one with adenomatous structure showed cystic dilatation of the tubules and abundant stroma. From these findings this case was compatible with juvenile polyposis coli, on which McColl et al, reported for the first time in 1964. This is a very rare disorder. The number of reported cases in Japan is only nine, and that from foreign countries is about 70. This case had several gastric polyps in the antrum. Their histological features were similar to those of colonic juvenile polyps. Approximately ten cases with concomitant gastric polyps have been reported up date. Those histological diagnosis was hyperplastic polyp or juvenile polyp. Therefore, juvenile polyposis coli may be a disease entity involved in total gastrointestinal polyposis. This case had moderate splenomegaly, however, the etiology was unknown. He has no complaint now, a year after polypectomy.

View full abstract

Spontaneous cholecystocolic fistula is a rare disease. In Japan 16 cases have been reported previously. A 65-year-old man has admitted to our hospital with complaints of severe diarrhea and weight loss. Eight years ago he was diagnosed to have cholelithiasis. On admission, no abnormalities were found at physical examination, but GOT, GPT and LAP were slightly elevated. An abdominal plain film showed air in the biliary tree. Barium enema and ERCP revealed the presence of a fistula by abnormal flow of the constrast medium. Subsequently he had colonoscopy and the fistula was found in the transversecolon near the hepatic flexure.Biopsy performed at the same time did not show malignancy. It is concluded that the active and rapid performance of endoscopical examination would be necessary for the correct diagnosis of this disease.

View full abstract

A 59-year-old man was admitted to the Tokiwagi Hospital, Mizusawa, Iwate, on January 27th, 1980 with a complaint of suddon onset of severe lower abdominal pain. There were no other pathognomic signs upon the physical examination, except for tenderness in the left iliac fossa and high blood pressure of 190/100mmHg. On the first hospital day he developed suddon bloody stools. About 12 hours after anal bleeding, he was given an instant barium enema. The radiological examination revealed narrowing, mucosal irre-gularity and thumb-printing signs of the sigmoid colon. Romanoscopic examination revealed severe edematous mucosa with small hemorrhages and multiple irregular ulcers. The biopsy specimen from the sigmoid colon showed tiny ulcerations and atrophy of glandular epithelia with depletion of o mucus production. Abdominal pain and bloody stools disappeared within several days by conservative therapies, and did not recur. Any irregularity was not observed by the barium enema on the 43rd day. As a conclusion, this case was diagnosed as the case of the transient form of ischemic colitis according to Marston's classification.

View full abstract

In recent years endoscopic biliary drainage has advanced as a nonsurgical internal biliary drainage. For inoperable cases of carcinoma of the pancreas or the biliary tract, this new biliary drainage method is especialy useful, because it is noninvasive physiological biliary drainage. Since last year, we have been successful in performing this procedure to those cases not only malignant but also benign diseases with biliary obstruction. Moreover, we developed this procedure to internal pancreatic drainage in a case of carcinoma of the duodenal papilla. This internal pancreatic drainage is able to decrease the internal pressure of the pancreatic duct, therefore it can improve abdominal pain and hyperamylasemia in patient of papilla or pancreatic carinoma, or chronic pancreatitis. We believe that endoscopic retrograde internal pancreatic drainage will be useful as a pallia-tive treatment of some pancreatic diseases in the near future.

View full abstract